Endoscopic Trans-Mini-Cylinder Biopsy for Intraparenchymal Brain Lesions

Purpose: Recently, the importance of molecular diagnosis has increased, along with the volume of specimens required for diagnosis. Biopsy procedures must simultaneously reduce invasiveness and ensure the collection of adequate tissue volume. We examined the efficacy and safety of endoscopic biopsy using a minimal diameter cylinder. Methods: : Patients who underwent endoscopic biopsy surgery with a 6-mm diameter cylinder for intraparenchymal lesions were included. Postoperative hematoma formation and the extent of trajectory scarring were assessed. Molecular genetic analysis was performed for cases of diffuse infiltrated glioma. Results: : Fifty-two procedures performed on 51 patients were analyzed in this study. Postoperative neurological deterioration was not observed in any case. A pathological diagnosis was made for all patients. Postoperative CT revealed no hematoma after 49 procedures and a small hematoma after 3 procedures, and no patients required additional treatment. A postoperative trajectory scar less than 5 mm in size was observed after 30 procedures, a scar of 5-10 mm was observed after 19 procedures, and a scar larger than 10 mm was observed after 3 procedures at 1 week after surgery, and 40, 6 and 0 scars were observed at 3 months after surgery. Molecular genetic analysis was performed in 17 cases, resulting in a change to a higher grade in the integrated diagnosis of 3 cases. Conclusions: : Endoscopic biopsy using a small-diameter cylinder is a possible alternative biopsy technique for intraparenchymal lesions. This surgical technique is useful especially in cases where hemorrhagic complications are expected. Trial registration Registry name and number: Efficacy and safety of the neuro-endoscopic treatment for brain tumors. (2019-0254)